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               <h1 id="article-title-1">Free DICOM Image Viewing and Processing Software for Your Desktop Computer: What’s Available and What It Can Do for You<a id="xref-aff-1-1" class="xref-aff" href="#aff-1">1</a></h1>
               <div class="contributors">
                  <ol class="contributor-list" id="contrib-group-1">
                     <li class="contributor" id="contrib-1"><span class="name"><a class="name-search" href="http://radiographics.rsna.org/search?author1=Edward+J.+Escott&amp;sortspec=date&amp;submit=Submit">Edward J. Escott</a></span><span class="contrib-degrees">, MD</span> and 
                     </li>
                     <li class="last" id="contrib-2"><span class="name"><a class="name-search" href="http://radiographics.rsna.org/search?author1=David+Rubinstein&amp;sortspec=date&amp;submit=Submit">David Rubinstein</a></span><span class="contrib-degrees">, MD</span></li>
                  </ol><p class="affiliation-list-reveal"><a href="#" class="view-more">+</a> Author Affiliations<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <ol class="affiliation-list hideaffil">
                     <li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>1</sup>From
 the Department of Radiology, University of Colorado Health Sciences 
Center, Campus Box A034, 4200 E Ninth Ave, Denver,
                           CO 80262. Presented as an education exhibit 
at the 2002 RSNA scientific assembly. Received March 3, 2003; revision 
requested
                           April 4 and received May 5; accepted May 20. <strong>Address correspondence to</strong> E.J.E. (e-mail: <em>edward.escott@uchsc.edu</em>).
                        </address>
                     </li>
                  </ol>
               </div>
               <div class="section abstract" id="abstract-1">
                  <div class="section-nav">
                     <div class="nav-placeholder">&nbsp;</div><a href="#sec-1" title="Introduction" class="next-section-link"><span>Next Section</span></a></div>
                  <h2>Abstract</h2>
                  
                  <p id="p-1">Whether or not a radiology department is 
“filmless,” there is often a need to store images digitally for teaching
 or presentation
                     purposes. Most computed tomographic and magnetic 
resonance images are in the Digital Imaging and Communications in 
Medicine
                     (DICOM) 3 format, which has many advantages; 
however, these files can be very large and rapidly consume storage 
space. Converting
                     DICOM files to smaller file formats such as the 
Joint Photographic Experts Group (JPEG) format can save space and allow 
insertion
                     of images into presentations created with software 
such as Microsoft PowerPoint. Some picture archiving and communication
                     systems can convert images from DICOM to other 
formats; however, many free options are also available. The World Wide 
Web
                     was searched for free DICOM image viewing or 
processing software, and programs that were thought to be user-friendly 
and compatible
                     with the Microsoft Windows operating systems were 
evaluated. There are many free programs that enable manipulation and 
processing
                     of DICOM images on a desktop computer, allowing the
 user to easily window images and convert them to a smaller and more 
usable
                     format, such as JPEG.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-2">© RSNA, 2003<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
               </div>
               <div class="section" id="sec-1">
                  <div class="section-nav"><a href="#abstract-1" title="Abstract" class="prev-section-link"><span>Previous Section</span></a><a href="#sec-2" title="Materials and Methods" class="next-section-link"><span>Next Section</span></a></div>
                  
                  <h2>Introduction</h2>
                  
                  <p id="p-3">More and more diagnostic imaging studies, 
including computed tomography (CT), magnetic resonance (MR) imaging, 
ultrasonography
                     (US), nuclear medicine studies, computed 
radiography, digital radiography, fluoroscopy, and digital subtraction 
angiography,
                     are performed, and the images often read, in a 
digital format. There is often the need to use these images in 
conferences
                     or in presentations; however, the DICOM (Digital 
Imaging and Communications in Medicine) format that most of these images
                     are in cannot be used by presentation software such
 as PowerPoint (Microsoft, Redmond, Wash) and many radiologists lack the
                     ability to manipulate these images on their desktop
 computers. In addition, DICOM images are quite large and converting 
these
                     files to a smaller format can improve transfer 
speed and decrease storage requirements. Some of the picture archiving 
and
                     communication systems (PACS) available offer the 
ability to convert DICOM images into other formats, but for those who 
lack
                     this ability, there is an assortment of free 
software available on the Internet that can allow the viewing and 
manipulating
                     of these images on a personal computer.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-4">We present a number of these programs, 
describe and compare their features, and suggest which are best suited 
to particular
                     purposes. Bear in mind that these programs are 
generously provided by their authors for free and were in all likelihood
 designed
                     to meet their personal needs and to operate best on
 whatever computer platform they are using. Unlike software available 
from
                     commercial vendors, it should not be expected that 
all of the programs listed will meet everyone’s needs, nor operate 
perfectly
                     with all operating systems. In fact, one of the 
programs listed (Imread) was designed by the authors; while it suits our
 needs
                     and we hope that others will find it useful as 
well, we are sure that some will find other programs more useful in 
their situations.
                     This article can be used as a guide to help select a
 few programs to try out, to ultimately determine which one will best
                     suit your particular needs.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
               </div>
               <div class="section" id="sec-2">
                  <div class="section-nav"><a href="#sec-1" title="Introduction" class="prev-section-link"><span>Previous Section</span></a><a href="#sec-3" title="A Word about Image File Formats" class="next-section-link"><span>Next Section</span></a></div>
                  
                  <h2>Materials and Methods</h2>
                  
                  <p id="p-5">The World Wide Web was searched for freely
 available DICOM viewing or processing software. Programs that were 
thought to be
                     user-friendly and compatible with the Windows 
(Microsoft) operating systems are presented and discussed. The commonly 
used
                     image file formats are reviewed. All programs 
reviewed are free, with the exception of the FP Image viewer. This was 
included
                     for comparison, since a 30-day evaluation version 
of this program is also installed when one installs the free DICOM 
browser
                     from this company.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-6">Initially, 42 total programs were briefly 
reviewed. Those that are not included in this review were omitted due to
 factors
                     such as the following: they were designed solely 
for operating systems other than Windows (mainly Macintosh [Apple 
Computer,
                     Cupertino, Calif]); they are primarily for a 
particular purpose, such as cardiac studies or functional MR imaging 
processing
                     only; they have only a command line program; they 
are not free or do not have a free version; they are not in English; the
                     program did not exist at the specified download 
site; or there was severe difficulty with the program that made it 
impossible
                     to adequately evaluate. In addition, there are 
DICOM “receiver” or “listener” programs available, which enable a 
computer
                     to receive DICOM images from other DICOM-compatible
 devices. A computer equipped with one of these programs is necessary if
                     one is to transfer images directly from a PACS 
reading station or other DICOM-compatible device to another computer. A 
review
                     of these programs is beyond the scope of this 
article; however, a number are available on the World Wide Web as well.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-7">All programs were reviewed on an Optiplex 
GS240 computer (Dell Computer, Austin, Tex) with a 2.0-GHz Pentium 4 
processor (Intel,
                     Santa Clara, Calif), 528 Mbytes of random-access 
memory (RAM), and the Windows 2000 operating system. In addition, all of
                     the programs that functioned adequately on this 
system were also evaluated on an Optiplex GX1 computer with a 350-MHz 
Pentium
                     2 processor, 128 Mbytes of RAM, and the Windows NT 
4.0 Service Pack 6 operating system.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-8">If images are received from multiple sources or compact disks, a DICOM viewer may have to deal with a wide variety of images.
                     A group of test images was used to test the ability of the viewers to display different types of images (<a id="xref-table-wrap-1-1" class="xref-table" href="#T1">Table 1</a>).
 Images varied in size from small (up to 512 × 512 pixels) to medium (up
 to 1,024 × 1,024 pixels) to large (up to 2,100
                     × 2,545 pixels). The test set contained images with
 header information that used implicit and explicit value representation
                     data elements. All images tested were with 
little-endian transfer syntax. Photometric interpretations tested were 
monochrome
                     1 (black-and-white, 0 = white), monochrome 2 
(black-and-white, 0 = black), and red-green-blue (color). Gray-scale 
images had
                     8 or 16 bits allocated. The 16-bit data tested had 
both signed and unsigned integers as the pixel representation, and cases
                     were selected that used a variety of the data bits 
stored, including 10, 12, 14, or 16 bits.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-9">In addition, one test DICOM image had 
lossless JPEG (Joint Photographic Experts Group) compression, one header
 contained overlay
                     data, and two headers contained thumbnail images. 
One test image had a somewhat unusual slope of 2.81525. One test image,
                     a screen-saved head CT image, used the full 16 bits
 of data by adding text that had black and white at the extremes of the
                     gray-scale range (ie, white text assigned 32,767, 
black surrounding the text assigned −32,768); therefore, the image data
                     occupied only a small part of the gray-scale 
spectrum. Test images were also selected that encompassed the wide 
variability
                     of modalities available. This included images of 
varying sizes, black-and-white as well as color images, multiple series 
of
                     images, screen-saved images, and scanned as well as
 native digital images, including CT scans, MR images, mammograms, and
                     chest radiographs. An additional pre-DICOM, 
ACR-NEMA (American College of Radiology–National Electrical 
Manufacturers Association)
                     type image was used to test the ability of programs
 to read these older images as well.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-10">The programs were evaluated on their 
abilities to open, view, window, and save each type of image, as well as
 on their image
                     processing features, documentation, and suitability
 to particular purposes. Specific image processing features evaluated 
were
                     the abilities to zoom, crop, resize, and rotate. As
 it is often helpful to load a series of images at a time, programs were
                     also evaluated for their ability to load image 
“stacks” (the ability to load more than one image of a series at a time 
in
                     a single window) and their ability to view images 
in a “cine” or “slide show” mode, which allows one to page through 
multiple
                     images in a single window. Some programs have the 
ability to annotate images with text, view the DICOM header information,
                     “anonymize” images, or measure regions of interest 
in either arbitrary values or Hounsfield units, and these features are
                     noted as well. As these programs are free, a number
 of the developers make the source code (the program before it is 
compiled)
                     available. This code is available for some programs
 since they are “open source” and therefore encourage the contributions
                     of others, and others make the code available to be
 used as a component of other projects. For this evaluation, it was 
noted
                     which developers make their source code available.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-11">Programs were generally found to fall 
into one of three categories. Simple viewers are basic viewers with 
limited features,
                     designed primarily for viewing images, with limited
 processing and saving features. Processors with a radiology-type 
interface
                     have more sophisticated image processing features 
and have controls that would be more familiar to the radiologist, such 
as
                     windowing by using the mouse, the ability to load 
image series, and in some cases, more of a PACS-type screen layout. 
Processors
                     with a photoediting-type interface also have more 
sophisticated processing features, but windowing is more likely 
controlled
                     with sliders or by entering numbers rather than 
with the mouse, and they are more similar in their use and interface to 
familiar
                     commercial image processing programs such as 
PhotoShop (Adobe Systems, San Jose, Calif).
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-12">Programs were evaluated on their “ease of use” (user-friendliness), which was a subjective evaluation that encompassed the
                     following attributes:
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-13">1. The steps necessary to open an image, 
including how obvious the steps, graphical user interface (GUI) 
features, and menu
                     items were; if the image opened at a usable size 
and at the correct (saved) window and level; and how fast the image was 
opened.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-14">2. The steps necessary to window an 
image, including how obvious the steps and GUI features were; how easy 
it was to obtain
                     the desired window width and level; the speed of 
windowing; and if there was the ability to easily invert an image, if 
necessary.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-15">3. Additional steps necessary for image 
processing and saving, including how obvious or intuitive the steps, GUI
 features,
                     and menu items were for resizing, cropping, 
rotating, and saving; how many steps it took to select the directories 
for saving
                     an image; and if the program remembered the last 
location of the most recently saved and opened files.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-16">4. How obvious the steps and how clear the GUI features were for creating multiplanar reformation (MPR) images or maximum
                     intensity projection (MIP) images, if the feature was available.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-17">5. The comprehensiveness of the documentation and help files.<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-18">The term <em>performance</em> encompasses attributes such as the following:
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-19">1. The speed at which functions such as windowing, resizing, file opening, and saving took place.<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-20">2. The accuracy of windowing, including if it was possible and how easy it was to achieve a subjectively appropriate window
                     width and level for an image.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-21">3. If images opened at the correct window width and level or if they opened inverted or in an unusual manner, such as tiled.<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-22">In addition, since our presentation at the 2002 RSNA scientific assembly, some of the programs have been updated. All programs
                     with updates posted as of January 2003 were reevaluated.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
               </div>
               <div class="section" id="sec-3">
                  <div class="section-nav"><a href="#sec-2" title="Materials and Methods" class="prev-section-link"><span>Previous Section</span></a><a href="#sec-4" title="Results" class="next-section-link"><span>Next Section</span></a></div>
                  
                  <h2>A Word about Image File Formats</h2>
                  
                  <p id="p-23">DICOM is a standard for the communication
 of images and relevant data. It was designed as an expansion of the 
ACR-NEMA standard
                     and is intended to enable communication between the
 equipment of different manufacturers, as well as between different 
elements
                     of medical information systems. It represents the 
format in which radiologic images are sent from scanners and digital 
radiology
                     devices, as well as the protocol used to send them,
 and it requires special software and viewers to receive and view these
                     images on a personal computer. The current standard
 is DICOM 3 (<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a>).
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-24">TIFF (tagged image file format), JPEG, 
BMP, PICT, GIF (graphics interchange format), and PNG (portable network 
graphics) are
                     commonly used file formats and the main image file 
formats that most Windows and Macintosh computers recognize. These file
                     types are either compressed or uncompressed, with 
compressed images having their data altered by using various algorithms
                     to decrease the file size. Like many of the common 
image processing programs, such as PhotoShop, many of the tested 
programs
                     allow the degree of compression to be varied when a
 file is saved. TIFF, BMP, and PICT can be uncompressed. TIFF with LZW
                     (Lempel-Ziv-Welch) compression, GIF, and PNG are 
lossless compressed formats. TIFF and PICT can also use JPEG compression
                     algorithms. JPEG compression can be lossless or 
lossy (<a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a>–<a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a>).
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-25">Images need to be converted to one of 
these formats to use them easily in a Web browser or PowerPoint 
presentation. The choice
                     of which format depends on the image type and what 
the ultimate use of the image will be. For presentation purposes, larger
                     files are fine; however, for transmission over the 
World Wide Web, smaller files are necessary to keep downloading time to
                     a minimum. At some point, storage considerations 
become an issue, with compressed files taking less disk space than 
noncompressed
                     files. Trial and error for each type of image will 
determine what works best. Another method of decreasing the file size to
                     minimize the amount of compression used is to crop 
the image to show only the area of interest, thus making it smaller, or
                     to alter its resolution. The color depth can also 
be reduced; for example, reducing an image to 8-bit gray scale from 16-
                     or 12-bit will significantly decrease the image 
size. Likewise, saving a gray-scale image in 8-bit gray scale rather 
than
                     24-bit color (a common default format) will also 
result in a smaller file size.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-26">When choosing an image processing 
program, the ability to save in multiple file formats as well as the 
ability to control
                     the level of compression are useful features. If an
 image is going to be edited multiple times, it is advantageous to save
                     it in a format that does not use lossy compression,
 so that it does not go through multiple compressions, each time losing
                     data. In addition, if the image is resized or 
rotated multiple times, some degradation can occur (<a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a>).
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
               </div>
               <div class="section" id="sec-4">
                  <div class="section-nav"><a href="#sec-3" title="A Word about Image File Formats" class="prev-section-link"><span>Previous Section</span></a><a href="#sec-7" title="Discussion" class="next-section-link"><span>Next Section</span></a></div>
                  
                  <h2>Results</h2>
                  
                  <div id="sec-5" class="subsection">
                     
                     <h3>Program Features</h3>
                     
                     <p id="p-27">The programs evaluated ranged widely in their features as well as their interfaces (<a id="xref-table-wrap-2-1" class="xref-table" href="#T2">Tables 2</a>, <a id="xref-table-wrap-3-1" class="xref-table" href="#T3">3</a>).
 All programs evaluated had GUIs and therefore would have a familiar 
feel to Windows users. All programs required that the
                        user have some way of putting DICOM images into 
the personal computer, either by means of removable storage media, a 
server
                        equipped with DICOM-receiving software that is 
accessible to the personal computer, or similar receiving software on 
the personal
                        computer itself. The programs cover the spectrum
 from basic DICOM viewers with no saving ability to those with 
full-fledged
                        image processing software, and some also have 
three-dimensional (3D) processing capabilities. (Additional 3D 
processing programs
                        are also available and will be the subject of a 
future review.) All programs evaluated can open and view DICOM images 
from
                        any source, with the exception of SimpleDICOM, 
which can view only images received through its receiver program. The 
programs
                        otherwise varied greatly in their features.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                     <p id="p-28">One of the more simple viewers 
displays the image only in its native resolution (Unlimiter Viewer), 
whereas most of the others
                        have some ability to zoom the image to make it 
larger or smaller. Zooming becomes particularly useful when viewing 
smaller
                        images (256 × 256) or larger images, such as 
chest radiographs or scanned sheets of film. If these larger images 
cannot be
                        appropriately scaled, the entire image will not 
fit on most monitors, making viewing awkward. The zooming capabilities 
range
                        from choosing between full size and fitting the 
window in SimpleDICOM and limited zooming in JDicomViewer to more 
complete
                        scaling options in many of the other programs.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                     <p id="p-29">Zooming, which affects only the size 
at which the image is viewed, needs to be differentiated from true 
resizing of an image,
                        which actually changes the pixel resolution (eg,
 512 × 512 to 256 × 256). If a resized image is saved, the actual file 
size
                        will change, whereas zooming does not affect the
 saved file size. Programs with the resizing feature are DicomWorks, 
ImageJ,
                        Imread, IrfanView32, Jivex, MRIcro, OSIRIS, 
Sante Viewer, and XnView. Very limited resizing is available with 
JDicomViewer.
                        Resizing is useful for standardizing the sizes 
of multiple images or decreasing the size of the image file to enable an
 image
                        to be transferred faster over the Internet or to
 consume less storage space.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                     <p id="p-30">The “Platforms Supported” information 
was generally as supplied by the software developer. Although Windows XP
 is not listed
                        for many of the programs, informal testing on 
this platform showed that many of the programs will function with this 
operating
                        system as well.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                  </div>
                  
                  <div id="sec-6" class="subsection">
                     
                     <h3>Documentation and Ease of Use</h3>
                     
                     <p id="p-31">The programs varied widely in the 
documentation supplied as well as their ease of use. Some were more 
intuitive to use than
                        others, whereas some of the more complex 
programs have extensive documentation (AccuLite DICOM Viewer, 
DICOMscope, FP Image,
                        ImageJ, Jivex, MRIcro, OSIRIS, XnView). Many 
programs have documentation or FAQs (frequently asked questions) on 
their Web
                        sites. DicomWorks does not have any 
documentation, although there is a discussion forum on their Web site 
that can provide
                        some assistance. AccuLite DICOM Viewer, ezDICOM,
 FP Image, IrfanView32, JDicomViewer, Jivex, Sante Viewer, TomoVision, 
Unlimiter
                        Viewer, and XnView were the easiest to use for 
basic functions. As one might expect, the more complex programs have a 
somewhat
                        steeper learning curve, whereas the ones with 
more limited functionality were generally easier to use with little 
experience.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                  </div>
                  
               </div>
               <div class="section" id="sec-7">
                  <div class="section-nav"><a href="#sec-4" title="Results" class="prev-section-link"><span>Previous Section</span></a><a href="#sec-11" title="Conclusions" class="next-section-link"><span>Next Section</span></a></div>
                  
                  <h2>Discussion</h2>
                  
                  <p id="p-32">There is a wide variety of programs 
available with a wide variety of features. They basically fall into 
three categories:
                     basic viewers with limited features; processors 
with a radiology-type interface (windowing with the mouse, the ability 
to
                     load image series); and processors with a 
photoediting-type interface (slider contrast and brightness adjustments,
 arbitrary
                     values of optical density, less likely to have the 
capability to load images as a series) (<a id="xref-table-wrap-4-1" class="xref-table" href="#T4">Table 4</a>). Some of the programs in the last category are primarily designed for general (nonmedical) image processing and also have
                     the ability to work with DICOM images.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <div id="sec-8" class="subsection">
                     
                     <h3>Simple Viewers</h3>
                     
                     <p id="p-33">Some of the more simple viewers lack 
the ability to save an image in non-DICOM formats and would require the 
use of a screen
                        capture program to transfer the image into the 
common image file formats; however, they will allow the viewing of 
images on
                        a personal computer, if that is all that is 
required (DICOMscope, FP Image Free Dicom Browser, Jivex, Unlimiter 
Viewer). The
                        other programs do allow saving of images in 
other formats, but they generally have fewer options than programs in 
the other
                        categories. ezDICOM (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a>)
 can also convert images to the Analyze format (which is discussed 
later). Some of the other programs in this category that
                        have more processing features might still need 
to be used in conjunction with other image processing software to create
 a
                        final image useful in all situations, such as to
 add annotation (SimpleDICOM). TomoVision saves files only as bitmap 
images;
                        therefore, if the image is to be used on the Web
 or stored in a compressed format, another program would be required to 
perform
                        the conversion to JPEG or GIF or some other 
compressed format. Also, some image processing programs had problems 
opening the
                        bitmap images created by TomoVision. Some 
programs (JDicomViewer, Unlimiter Viewer) have either limited windowing 
capabilities
                        or difficulty windowing some of the DICOM images
 correctly.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                  </div>
                  
                  <div id="sec-9" class="subsection">
                     
                     <h3>Processors with a Radiology Interface</h3>
                     
                     <p id="p-34">Some of the programs in this category 
provide all the features needed to transform almost any DICOM image into
 a cropped,
                        appropriately windowed, and possibly annotated 
image in a personal computer–“friendly” format that can be used in 
presentation
                        programs or on the Web (FP Image [trial 
version], Imread, OSIRIS, Sante Viewer). DicomWorks (<a id="xref-fig-2-1" class="xref-fig" href="#F2">Fig 2</a>)
 lacks only a few features, such as cropping and resizing. Most programs
 in this category allow the saving of images in multiple
                        file formats, except for AccuLite DICOM Viewer, 
which saves files only as bitmap images. In addition to being able to 
save
                        in multiple standard file formats, OSIRIS has 
the ability to save images in its own format (Papyrus). DicomWorks has 
the ability
                        to display multiple series at a time and is the 
closest program evaluated to having an interface similar to that of a 
PACS
                        reading station; however, although it supports 
the saving of images in multiple formats, it would need to be used with 
another
                        program to fully process images for 
presentations. Most of the programs in this category as well as in the 
other categories
                        that have the ability to annotate do so only 
with text; therefore, if one wanted to add arrows, another program would
 need
                        to be used.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                  </div>
                  
                  <div id="sec-10" class="subsection">
                     
                     <h3>Processors with a Photoediting Interface</h3>
                     
                     <p id="p-35">Most of the programs in this category 
also provide a comprehensive feature set to fully convert DICOM images 
into a fully
                        processed image in a format that can be used on 
the Web or in presentations (ImageJ, IrfanView32, XnView [<a id="xref-fig-3-1" class="xref-fig" href="#F3">Fig 3</a>]).
 Programs such as MRIcro would have to be used in conjunction with 
another program if cropping of the image were necessary.
                        XnView and IrfanView32 had some difficulty 
appropriately windowing some of the DICOM images. MRIcro can convert 
DICOM images
                        into the Analyze format, which is used by some 
of the programs used to process functional imaging studies, such as SPM,
 and
                        MRIcro has features tailored to preparing images
 for further processing such as for functional MR imaging. Therefore, 
this
                        program is suited to those interested in image 
evaluation and advanced processing. ImageJ is another program suited for
 more
                        advanced image processing.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                     <p id="p-36">Some of the programs are a DICOM 
browser (FP Image Free Dicom Browser) or include a DICOM browser 
(DicomWorks, FP Image, IrfanView32,
                        OSIRIS, Sante Viewer, XnView), which will show 
thumbnails of the DICOM images in a directory. This feature is useful if
 you
                        want to quickly select a particular image from 
an entire study.
                     <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                     
                  </div>
                  
               </div>
               <div class="section" id="sec-11">
                  <div class="section-nav"><a href="#sec-7" title="Discussion" class="prev-section-link"><span>Previous Section</span></a><a href="#sec-12" title="Next Section" class="next-section-link"><span>Next Section</span></a></div>
                  
                  <h2>Conclusions</h2>
                  
                  <p id="p-37">Overall, there are many programs to 
choose from, with many capabilities. It is best to choose a few and try 
them out for a
                     while to find the one or two that best suit your 
needs. As with most free software, one must bear in mind that these 
programs
                     are provided by the generosity of their developers,
 and a number of the programs may need to be tried to find the one that
                     best suits your purposes.
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
                  <p id="p-38">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div id="F1" class="fig pos-float odd">
                     <div class="fig-inline"><a href="http://radiographics.rsna.org/content/23/5/1341/F1.expansion.html"><img alt="Figure" src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/F1.gif"></a><div class="callout"><span>View larger version:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/F1.expansion.html">In this page</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/F1.expansion.html">In a new window</a></li>
                           </ul>
                           <ul class="fig-services">
                              <li class="ppt-link"><a href="http://radiographics.rsna.org/powerpoint/23/5/1341/F1">Download as PowerPoint Slide</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="fig-caption">
                        
                        <p id="p-39" class="first-child"><strong>Figure 1.</strong>&nbsp;&nbsp;Screen
 from ezDICOM. The interface for this simple viewer is straightforward, 
with the familiar menu bar across the top.
                           Note the options for image manipulation on 
the drop-down menu (with hot keys) and that the image is displayed in a 
separate
                           pane. The size of the image, as well as the 
window width and level, are displayed on the information bar across the 
bottom
                           of the main window. Note that the window 
width and level are in Hounsfield units; the number in the lower left 
corner would
                           be the Hounsfield unit value under the cursor
 if the cursor were located over the image.
                        <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
                  <p id="p-40">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div id="F2" class="fig pos-float odd">
                     <div class="fig-inline"><a href="http://radiographics.rsna.org/content/23/5/1341/F2.expansion.html"><img alt="Figure" src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/F2.gif"></a><div class="callout"><span>View larger version:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/F2.expansion.html">In this page</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/F2.expansion.html">In a new window</a></li>
                           </ul>
                           <ul class="fig-services">
                              <li class="ppt-link"><a href="http://radiographics.rsna.org/powerpoint/23/5/1341/F2">Download as PowerPoint Slide</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="fig-caption">
                        
                        <p id="p-41" class="first-child"><strong>Figure 2.</strong>&nbsp;&nbsp;Screen
 from DicomWorks. The interface is more similar to that of a PACS 
reading station, with a patient browser on the left
                           and different series of images with different
 windowing displayed in the four frames to the right. Each series can be
 scrolled
                           independently, or they can be linked so that 
they scroll simultaneously. Windowing is performed by using the mouse. 
These
                           features are more typical of a processor with
 a radiology interface. The menu bar is again across the top, and the 
graphical
                           menu is below it.
                        <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
                  <p id="p-42">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div id="F3" class="fig pos-float odd">
                     <div class="fig-inline"><a href="http://radiographics.rsna.org/content/23/5/1341/F3.expansion.html"><img alt="Figure" src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/F3.gif"></a><div class="callout"><span>View larger version:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/F3.expansion.html">In this page</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/F3.expansion.html">In a new window</a></li>
                           </ul>
                           <ul class="fig-services">
                              <li class="ppt-link"><a href="http://radiographics.rsna.org/powerpoint/23/5/1341/F3">Download as PowerPoint Slide</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="fig-caption">
                        
                        <p id="p-43" class="first-child"><strong>Figure 3.</strong>&nbsp;&nbsp;Screen
 from XnView. The interface has both a menu bar and graphical menu 
items. Note the image information on the information
                           bar across the bottom of the window. The 
Image → Adjust → Brightness/Contrast/Gamma correction/Color balance 
window is open
                           and shows that image adjustment is performed 
with sliders or by entering numbers, rather than with the mouse. This 
feature
                           is similar to those of the other programs in 
the category of processors with a photoediting interface.
                        <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
                  <p id="p-44">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div class="table pos-float" id="T1">
                     <div class="table-inline">
                        <div class="callout"><span>View this table:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/T1.expansion.html">In this window</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/T1.expansion.html">In a new window</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="table-caption">
                        
                        <p id="p-45" class="first-child">TABLE 1. Properties of the Test Images<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
                  <p id="p-49">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div class="table pos-float" id="T2">
                     <div class="table-inline">
                        <div class="callout"><span>View this table:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/T2.expansion.html">In this window</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/T2.expansion.html">In a new window</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="table-caption">
                        
                        <p id="p-50" class="first-child">TABLE 2. Features of the Software: Part 1<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
                  <p id="p-57">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div class="table pos-float" id="T3">
                     <div class="table-inline">
                        <div class="callout"><span>View this table:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/T3.expansion.html">In this window</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/T3.expansion.html">In a new window</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="table-caption">
                        
                        <p id="p-58" class="first-child">TABLE 3. Features of the Software: Part 2<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
                  <p id="p-60">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  <div class="table pos-float" id="T4">
                     <div class="table-inline">
                        <div class="callout"><span>View this table:</span><ul class="callout-links">
                              <li><a href="http://radiographics.rsna.org/content/23/5/1341/T4.expansion.html">In this window</a></li>
                              <li><a target="_blank" class="in-nw-vis" href="http://radiographics.rsna.org/content/23/5/1341/T4.expansion.html">In a new window</a></li>
                           </ul>
                        </div>
                     </div>
                     <div class="table-caption">
                        
                        <p id="p-61" class="first-child">TABLE 4. Categories of Viewers<div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                        <div class="sb-div caption-clear"></div>
                     </div>
                  </div>
                  
               </div>
               <div class="section" id="sec-12">
                  <div class="section-nav"><a href="#sec-11" title="Conclusions" class="prev-section-link"><span>Previous Section</span></a><a href="#fn-group-1" title="Footnotes" class="next-section-link"><span>Next Section</span></a></div>
                  
                  
                  <p id="p-63">
                     
                     
                  <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                  
               </div>
               <div class="section fn-group" id="fn-group-1">
                  <div class="section-nav"><a href="#sec-12" title="Previous Section" class="prev-section-link"><span>Previous Section</span></a><a href="#ref-list-1" title="References" class="next-section-link"><span>Next Section</span></a></div>
                  <h2>Footnotes</h2>
                  <ul>
                     <li class="fn" id="fn-12">
                        
                        <p id="p-64">Abbreviations: ACR = American College of Radiology,
                           DICOM = Digital Imaging and Communications in Medicine,
                           GIF = graphics interchange format,
                           GUI = graphical user interface,
                           JPEG = Joint Photographic Experts Group,
                           MIP = maximum intensity projection,
                           MPR = multiplanar reformation,
                           NEMA = National Electrical Manufacturers Association,
                           PACS = picture archiving and communication system,
                           PNG = portable network graphics,
                           TIFF = tagged image file format,
                           3D = three-dimensional
                        <div style="position: absolute; left: 536px; top: 8404px; background-color: rgb(255, 255, 255); border: 0pt none; padding: 0pt;" class="hotlight"><a target="_blank" href="http://myhotlight.net/hotlight.php?ref=http://radiographics.rsna.org/content/23/5/1341.long&amp;query=PACS%20reading%20station"><img src="Free%20DICOM%20Image%20Viewing%20and%20Processing%20Software%20for%20Your%20Desktop%20Computer_files/query.jpg"></a></div></p>
                        
                     </li>
                  </ul>
               </div><span class="rsna-kwd-group INDEX"><span class="rsna-kwd-header">Index terms:</span>
                  <span class="rsna-kwd">Digital imaging and communications in medicine (DICOM)</span><span class="rsna-kwd-sep">; </span>
                  <span class="rsna-kwd">Images, display</span><span class="rsna-kwd-sep">; </span>
                  <span class="rsna-kwd">Images, processing</span><span class="rsna-kwd-sep">; </span>
                  <span class="rsna-kwd">Software reviews</span>
                  </span><ul class="history-list"></ul>
               <div class="section ref-list" id="ref-list-1">
                  <div class="section-nav"><a href="#fn-group-1" title="Footnotes" class="prev-section-link"><span>Previous Section</span></a><div class="nav-placeholder">&nbsp;</div>
                  </div>
                  <h2>References</h2>
                  <ol class="cit-list">
                     <li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a>
                        
                        
                        <div class="cit ref-cit ref-other" id="cit-23.5.1341.1">
                           <div class="cit-metadata"><cite><span class="cit-source">Digital Imaging and Communications in Medicine (DICOM)</span> Rosslyn, Va: National Electrical Manufacturers Association,  <span class="cit-pub-date">2001</span>. PS 3.1-2001, pp iii–iv, 4–12.</cite></div>
                           <div class="cit-extra"></div>
                        </div>
                        
                     </li>
                     <li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a>
                        
                        
                        <div class="cit ref-cit ref-other" id="cit-23.5.1341.2">
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